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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I hsve (esd ~LCld agree to the terms stated on the reverse side of <br />this document. <br /> <br />OWNE~ArE: 09/27/94 TIHE: 12:u2:37 ~ TAX LOT: !CATEGORY: <br />!SiTU~ ~M .HOME. S ; CONSTRUCTION TYPE: ~Z~L <br /> <br /> 11~73 MILL CREEK R~ SE <br /> PHONE= 7&~-7744 ~ V~LU~TION: <br /> <br /> TYPE: NANUFACTURED STRUCTURE PERHIT OR APPLICATION <br /> CSMTRACTOR~ NO. 98?40 <br /> Capitol Aw~i~g~/ Samtiam Homes <br />518 Valleywooa ~r SE <br />Salem~ <br />PHONE: 3&M-1711 <br /> <br />ITEM <br />MANUFACTURED STRUCTURE PLACEMENT/CONNECTION <br />MAMUFACTURED STRUCTURE ~TATE FEE <br />MAMUFACTURE~ STRUCTURE STATE SURCHARGE <br /> <br /> TOTALASSESSEB FEES <br /> : PREVIOUS RECEIPTS <br /> , THIS :RECEIPT <br /> : :: :~ALANCE DOE <br />PAYEE: Capitol Awning / <br />RECEIVEQ BY: DF <br /> <br />9858478 <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $182.00 <br /> $28.00 <br /> $9.10 <br /> <br />$211,10 <br /> $0.00 <br />$211.I0 <br /> <br />$0.00 <br /> <br /> INVOICE 61829 <br /> ::,: CHECK ~: 0 <br /> * THIS IS NOT A PERMIT. PROCESS ~MERE THE <br /> FOLLONZNG HUST BE COHPLETED. IT:IS THE::RESPUNSI~IEITYOF THE APPLICANT TO ASSURE <br /> THAT ALL NECESSARY INFORt,~,e~T[ON, HASBEEH <br /> <br />PLAHHIM6 ACTION: <br /> <br /> . <br /> RS-15 <br /> RR"'15 <br /> CITY JURISDZCTION: BY ............. DATE <br /> REMARKS: MS, CARPORT <br /> <br /> OFFICE COPY <br />;RM # MC 1~-~(i REV, 4/90 <br /> <br /> <br />